Cellulitis resident survival guide
|Cellulitis Resident Survival Guide Microchapters|
Cellulitis is the inflammation of deeper layers of the skin including the dermis and subcutaneous tissue. It is mostly due to a bacterial infection. The bacteria usually invades the deeper layers after breaching the skin barrier. Common bacteria such as streptococcus pyogenes, staphylococcus aureus, haemophilus influenza type B, clostridium, streptococcus pneumoniae and neisseria meningitidis usually involve the lower limbs. It presents clinically with signs of inflammation such as redness, swelling, warmth and pain. Risk factors for cellulitis include a weakened immune system, diabetes, lymphatic obstruction, and varicose veins. It is recommended to first rule out deep vein thrombosis (DVT) with compression doppler ultrasound of the limbs and d-dimer level. Elevated levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and leukocytosis could be detected. It is required to check systemic signs of infection. It is treated conservatively with oral antibiotics in uncomplicated cases. Parenteral antibiotics are administered in patients with systematic symptoms and progressive lesions. Incision and drainage are done if discrete abscesses are present.
No known life-threatening causes are included.
- Streptococcus pyogenes
- Staphylococcus aureus
- Haemophilus influenza type B
- Streptococcus pneumoniae
- Neisseria meningitidis
|Perform compression doppler ultrasound of the limb and D-dimer level|
|Deep vein thrombosis (DVT) is likely.||DVT unlikely. High clinical suspicion for cellulitis|
|Assess levels of inflammatory markers|
|Raised erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and leukocytosis|
Does the patient have any of the following signs of systemic or rapidly progressive infection?
|Assess patient's risk for infective endocarditis|
- Supportive care including elevation of the limb and adequate moisturizing of the cellulitis site should be done. The elevation of the limb promotes venous and lymphatic drainage from the site. Moisturize the affected site with emollients and moisturizers. It will hydrate the skin and prevent breakouts.
- Physicians should prescribe antibiotics for patients according to their body weight. Obese or lymphedema patients can be given a lower dose than their body weight, which results in inadequate response and failure of the treatment.
- The duration of antibiotic treatment is variable and depends upon the clinical improvement of the cellulitis. Mostly, there is significant improvement within a day or two after the initiation of the antibiotics. The patient should receive the treatment for five days. The antibiotic course is given for two weeks in patients with systematic symptoms, low immunity, and rapidly progressive cellulitis.
- Suppressive antibiotic therapy is administered to patients with three to four episodes of cellulitis per year with predisposing factors that can not be alleviated. Suppressive antibiotic therapy is directed against beta-hemolytic streptococci and staphylococci infection. Suppressive antibiotic therapy is not beneficial in patients with greater than three episodes of cellulitis in a year, chronic edema, and obesity.
- Physicians should not perform incision and drainage for discrete abscesses in patients with high susceptibility of bacterial endocarditis without prior administration of the antibiotic. 2 grams of oral amoxicillin should be given to the patient an hour before performing incision and drainage of the infected site.
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